Dr. Mary Claire Haver

It's the good bacteria.

What does lactobacilli make?

Lactic acid.

What does lactic acid do?

Decreases the pH of the vagina and keeps it healthy.

When you lose your androgens and your estrogens, you see a cascading pathway that will lead to an increase in the pH, lack of that lactobacilli, and then a recolonization with unhelpful bacteria.

Oh my God.

So for recurrent BV, how are you treating this?

So I want to restore the natural microbiome.

So I will give people, I mean, especially in menopausal women, like the bottom line is we need to restore their estrogens and then I'll give them androgens as well in the form of prostorone.

And even for premenopausal women, I'll do that.

If the FDA approved regimens aren't working, I think about what's going on in this microbiome.

No.

Okay.

Why?

So it's this idea of they're testing usually salivary hormones and salivary hormones have never been shown to be correlated to blood level hormones.

And again, I'm going to go back to the receptor.

The hormone in your saliva looks different than the hormone that's in your blood.

And the hormone that's in your blood is the one that is directly acting on the receptors.

Right.